胰岛素低血糖激发试验出现不充分低血糖的影响因素研究

马佳妮; 郑晓雅; 沈雅尹; 周馨怡; 谢雪瑞; 刘杰; 任伟

doi:10.16016/j.2097-0927.202203170

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胰岛素低血糖激发试验出现不充分低血糖的影响因素研究

临床医学 | 更新时间：2026-01-09

- 胰岛素低血糖激发试验出现不充分低血糖的影响因素研究
- Influencing factors for inadequate hypoglycemia in insulin tolerance test
- 陆军军医大学学报 2022年44卷第22期页码：2324-2329
- 作者机构：
  
  400010 重庆, 重庆医科大学附属第一医院内分泌科
- 作者简介：
  
  [任伟，E-mail: renwei67@sina.com REN Wei, E-mail: renwei67@sina.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202203170
  中图分类号： R446.112;R584.2
- 收稿：2022-03-19，
  
  修回：2022-05-24，
  
  纸质出版：2022-11-30
- 稿件说明：
移动端阅览
马佳妮, 郑晓雅, 沈雅尹, 等. 胰岛素低血糖激发试验出现不充分低血糖的影响因素研究[J]. 陆军军医大学学报, 2022,44(22):2324-2329.

Jiani MA, Xiaoya ZHENG, Yayin SHEN, et al. Influencing factors for inadequate hypoglycemia in insulin tolerance test[J]. Journal of Army Medical University, 2022, 44(22): 2324-2329.
马佳妮, 郑晓雅, 沈雅尹, 等. 胰岛素低血糖激发试验出现不充分低血糖的影响因素研究[J]. 陆军军医大学学报, 2022,44(22):2324-2329. DOI： 10.16016/j.2097-0927.202203170.

Jiani MA, Xiaoya ZHENG, Yayin SHEN, et al. Influencing factors for inadequate hypoglycemia in insulin tolerance test[J]. Journal of Army Medical University, 2022, 44(22): 2324-2329. DOI： 10.16016/j.2097-0927.202203170.

摘要

目的

研究胰岛素低血糖激发试验(insulin tolerance test，ITT)按指南推荐剂量注射胰岛素后出现不充分低血糖的影响因素。

方法

采用横断面研究设计，选取2010年01月至2021年12月于重庆医科大学附属第一医院内分泌科就诊的可疑成人生长激素(growth hormone，GH)缺乏患者，共416例(男性121例，女性295例)，均行ITT。收集患者资料及生化信息，根据ITT过程中单次指南推荐剂量注射胰岛素(0.1~0.15 U/kg)后低血糖是否充分进行分组(充分低血糖组321人，不充分低血糖组95人)。采用多因素Logistic回归模型分析不充分低血糖的影响因素；采用受试者工作特征(receiver operating characteristic

ROC) 曲线分析相关指标对不充分低血糖的预测价值，得出切点值。

结果

充分低血糖组的年龄、体质指数(body mass index

BMI)、首次胰岛素剂量、基线血糖、基线GH、空腹胰岛素、糖化血红蛋白(glycosylated hemoglobin A1c

HbA1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterin

LDL-C)、甘油三酯(triglyceride，TG)均低于不充分低血糖组，高密度脂蛋白胆固醇(high density lipoprotein cholesterin

HDL-C)高于不充分低血糖组(

0.05)。多因素Logistic回归分析结果显示，高BMI、高基线血糖、高LDL-C、低HDL-C是不充分低血糖的影响因素(

0.05)。BMI预测不充分低血糖的ROC曲线下面积(area under the ROC curve

AUC) 为0.880，约登指数计算此时BMI切点值为24.012，敏感度为0.832，特异度为0.804。BMI、基线血糖、LDL-C、HDL-C四者联合诊断预测不充分低血糖的AUC为0.909

敏感度为0.895，特异度为0.782。

结论

高BMI、高基线血糖、高LDL-C、低HDL-C为不充分低血糖的影响因素，四者联合检测和BMI单一指标均对不充分低血糖有较高的预测价值。

Abstract

Objective

To investigate the influencing factors of inadequate hypoglycemia after insulin injection at the guideline-recommended dose in the insulin tolerance test (ITT).

Methods

A cross-sectional study was conducted on 416 patients with suspected adult growth hormone (GH) deficiency (121 males and 295 females) in the outpatient department and inpatient department of endocrinology in the First Affiliated Hospital of Chongqing Medical University from January 2010 to December 2021. All patients completed the ITT. The clinical data and biochemical information of the patients were collected

according to whether hypoglycemia was sufficient after a single dose of insulin injection (0.1~0.15 U/kg) recommended by the guidelines during ITT. The patients were divided into the adequate group (

=321) and the inadequate group (

=95). Multivariate logistic regression model was used to analyze the influencing factors of inadequate hypoglycemia. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of relevant indicators for inadequate hypoglycemia and to get the cut-off value.

Results

Age

BMI

initial insulin dose

baseline bloo

d glucose

baseline GH

fasting insulin

glycated hemoglobin A1c (HbA1c)

low density lipoprotein cholesterin(LDL-C) and triglyceride(TG) in the sufficient hypoglycemia group were lower than those in the inadequate hypoglycemia group

and high density lipoprotein cholesterin (HDL-C) was higher than that in the hypoglycemia group (

0.05). Multivariate logistic regression model showed that high BMI

high baseline blood glucose

high LDL-C level and low HDL-C level were the influencing factors of inadequate hypoglycemia (

0.05). The area under ROC curve (AUC) of BMI predicting hypoglycemia was 0.880

and the cut-off point of BMI calculated by Jorden index was 24.012

with a sensitivity of 0.832 and specificity of 0.804. The AUC of BMI

baseline blood glucose

LDL-C and HDL-C in the combined diagnosis of inadequate hypoglycemia was 0.909 (sensitivity

0.895; specificity

0.782).

Conclusion

High BMI

high baseline blood glucose

high LDL-C level and low HDL-C level are the influencing factors of inadequate hypoglycemia. The combined detection of these 4 factors and BMI single index both have a high predictive value on inadequate hypoglycemia.

关键词

Keywords

references

MOLITCH M E, CLEMMONS D R, MALOZOWSKI S, et al . Evaluation and treatment of adult growth hormone deficiency: an endocrine society clinical practice guideline[J ] . J Clin Endocrinol Metab, 2011, 96(6): 1587-1609. DOI: 10.1210/jc.2011-0179.

GUPTA V. Adult growth hormone deficiency[J]. Indian J Endocrinol Metab, 2011, 15(Suppl 3): S197-S202. DOI: 10.4103/2230-8210.84865.

BURMAN P, MATTSSON A F, JOHANNSSON G, et al . Deaths among adult patients with hypopituitarism: hypocortisolism during acute stress, and de novo malignant brain tumors contribute to an increased mortality[J ] . J Clin Endocrinol Metab, 2013, 98(4): 1466-1475. DOI: 10.1210/jc.2012-4059.

GASCO V, FERRERO A, BISCEGLIA A, et al . The cut-off limits of growth hormone response to the insulin tolerance test related to body mass index for the diagnosis of adult growth hormone deficiency[J ] . Neuroendocrinology, 2021, 111(5): 442-450. DOI: 10.1159/000508103.

SIMPSON H, SAVINE R, SÖNKSEN P, et al . Growth hormone replacement therapy for adults: into the new millennium[J ] . GrowthHorm IGF Res, 2002, 12(1): 1-33. DOI: 10.1054/ghir.2001.0263.

SVENSSON J, BENGTSSON B A, ROSÉN T, et al . Malignant disease and cardiovascular morbidity inhypopituitary adults with or without growth hormone replacement therapy[J ] . J Clin Endocrinol Metab, 2004, 89(7): 3306-3312. DOI: 10.1210/jc.2003-031601.

GABREANU G R. An update on the diagnosis of growth hormone deficiency[J]. Discoveries (Craiova), 2018, 6(1): e82. DOI: 10.15190/d.2018.2.

中华医学会内分泌学分会. 成人生长激素缺乏症诊治专家共识(2020版)[J]. 中华内分泌代谢杂志,2020, 36(12): 995-1002. DOI: 10.3760/cma.j.cn311282-20201130-00798

Branch of Endocrinology of Chinese Medical Association. Expert consensus on diagnosis and treatment of adult growth hormone deficiency(2020)[J]. Chin J Endocrinol Metab, 2020, 36(12): 995-1002. DOI: 10.3760/cma.j.cn311282-20201130-00798

张豫文, 孙首悦, 陈宇红, 等. 关于优化胰岛素低血糖-生长激素刺激试验中胰岛素用量计算方法的初步探索[J]. 中华内分泌代谢杂志, 2017(1): 29-33.

ZHANG Y W, SUN S Y, C HEN Y H, et al . Optimizing the method in calculating the insulin dosages in the insulin hypoglycemia-growth hormone stimulation test: preliminary exploration[J ] . Chin J Endocrinol Metab, 2017(1): 29-33.

王敏. BMI和胰岛素抵抗在非糖尿病人群中的关系研究[D]. 长春: 吉林大学, 2021.

WANG M. Study on the associations between BMI and insulin resistance in non-diabetic population[D]. Changchun: Jilin University, 2021.

MVLLER-WIELAND D, KOTZKA J. Correction of insulin resistance and the metabolic syndrome[J]. Handb Exp Pharmacol, 2005(170): 591-617. DOI: 10.1007/3-540-27661-0_22.

KAHN B B, FLIER J S. Obesity and insulin resistance[J]. J Clin Invest, 2000, 106(4): 473-481. DOI: 10.1172/JCI10842.

MALIK S U F, MAHMUD Z, ALAM J, et al . Relationship among obesity, blood lipids and insulin resistance in Bangladeshi adults[J ] . Diabetes Metab Syndr, 2019, 13(1): 444-449. DOI: 10.1016/j.dsx.2018.10.015.

AJALA O, LOCKETT H, TWINE G, et al . Depth and duration of hypoglycaemia achieved during the insulin tolerance test[J ] . Eur J Endocrinol, 2012, 167(1) : 59-65. DOI: 10.1530/EJE-12-0068.

SARLOS S, INDER W J. Selective use of the insulin tole rance test to diagnose hypopituitarism[J]. Intern Med J, 2013, 43(1): 89-93. DOI: 10.1111/imj.12011.

LEE P, GREENFIELD J R, HO KK Y. Factors determining inadequate hypoglycaemia during insulin tolerance testing (ITT) after pituitary surgery[J]. Clin Endocrinol (Oxf), 2009, 71(1): 82-85. DOI: 10.1111/j.1365-2265.2008.03466.x.

LANGE M, SVENDSEN O L, SKAKKEBAEK N E, et al . An audit of the insulin-tolerance test in 255 patients with pituitary disease[J ] . Eur J Endocrinol, 2002, 147(1): 41-47. DOI: 10.1530/eje.0.1470041.

TAKAHASHI K, NAKAMURA A, MIYOSHI H, et al . Factors associated with an inadequate hypoglycemia in the insulin tolerance test in Japanese patients with suspected or proven hypopituitarism[J ] . Endocr J, 2017, 64(4): 387-392. DOI: 10.1507/endocrj.EJ16-0332.

李林蔓, 任伟, 李金超, 等. ITT试验的诊断价值及安全性观察[J]. 解放军医学杂志, 2012, 37(4): 346-349.

LI L M, REN W, LI J C, et al . Clinical observation of diagnostic value and safety of insulin tolerance test[J ] . Med J Chin PLA, 2012, 37(4): 346-349.

BINDER G, BOSK A, GASS M, et al . Insulin tolerance test causes hypokalaemia and can provoke cardiac arrhythmias[J ] . Horm Res, 2004, 62(2): 84-87. DOI: 10.1159/000079539.

SHAH A, STANHOPE R, MATTHEW D. Hazards of pharmac- ological tests of growth hormone secretion in childhood[J]. BMJ, 1992, 304(6820): 173-174. DOI: 10.1136/bmj.304.6820.173.

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